LexisNexis® Legal Newsroom
    Antitrust, Some ERISA Claims Dismissed From Wellpoint Reimbursement MDL

    LOS ANGELES - A federal judge in California on July 19 dismissed antitrust and other claims alleging that WellPoint Inc. and other companies conspired to use a flawed database to set the rates for which out-of-network medical services (ONS) are reimbursed (In re: WellPoint Inc. Out-Of-Network "UCR" Rates Litigation, MDL No. 2:09-ml-02074, C.D. Calif.).

    Federal Judge Reverses Decision, Grants Preliminary Injunction In Health Act Case

    OKLAHOMA CITY - Following instructions from the 10th Circuit U.S. Court of Appeals, an Oklahoma federal judge on July 19 reversed a previous decision and granted a preliminary injunction in favor of the arts and craft company Hobby Lobby Stores Inc. and its owners, halting the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control as it relates to the plaintiffs (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 12-1000, W.D. Okla.).

    Blue Cross Violates Fiduciary Duty By Setting, Imposing Fee, 6th Circuit Rules

    CINCINNATI - Blue Cross Blue Shield of Michigan (BCBSM) violated its fiduciary duties under the Employee Retirement Income Security Act by discretionarily setting and billing a self-funded benefits fund for a cost-transfer subsidy fee to satisfy its obligation to the State of Michigan, the Sixth Circuit U.S. Court of Appeals ruled July 18 in affirming summary judgment to the fund (Pipefitters Local 636 Insurance Fund, et al. v. Blue Cross and Blue Shield of Michigan, No. 12-2265, 6th Cir.; 2013 U.S. App. LEXIS 14517).

    Wisconsin Federal Judge Declines To Dismiss Medicaid Dispute

    MADISON, Wis. - A federal judge in Wisconsin on July 17 declined to dismiss a suit alleging that Wisconsin officials violated the plaintiffs' federal Medicaid rights by failing to furnish medical assistance under a program for childless adults, saying that the plaintiffs have a private right of action (Charles Wagner, et al. v. Wisconsin Department of Health Services, et al., No. 12-463, 2013 U.S. Dist. LEXIS 99629).

    High Court Denies Stay Pending Filing Of Certiorari In Medicaid Case

    WASHINGTON, D.C. - The U.S. Supreme Court on July 22 denied an application for a stay in a case in which the Ninth Circuit U.S. Court of Appeals vacated preliminary injunctions prohibiting the California Department of Health Care Services and its director from implementing Medi-Cal reimbursement reductions authorized by the California Legislature and approved by the secretary of the Department of Health and Human Services (Managed Pharmacy Care, et al. v. Kathleen Sebelius, et al., No. 13A13, U.S. Sup.).

    N.Y. Federal Judge Grants Health Insurer Judgment In Denial Of Benefits Case

    NEW YORK - A New York federal judge on July 17 granted summary judgment in favor of a health insurer in a wrongful denial of benefits suit, saying the denial of benefits was not arbitrary and capricious (Daniel Z. Stern v. Oxford Health Plans Inc., No. 12-2379, E.D. N.Y.; 2013 U.S. Dist. LEXIS 99962).

    Allocation Burden Was Properly Placed On Insured, Pennsylvania Majority Affirms

    HARRISBURG, Pa. - A majority of the Pennsylvania Superior Court found July 18 that a lower court properly placed the allocation burden on an insured in a professional liability coverage dispute over settlement and defense costs stemming from an underlying managed care multidistrict litigation (Executive Risk Indemnity Inc. v. CIGNA Corp., No. 1117 EDA 2012, Pa. Super.; 2013 Pa. Super. LEXIS 1662).

    Florida Appeals Panel Revives Couple's Claims Against Health Care Company

    MIAMI - The Third District Florida Court of Appeal on July 17 reversed a trial court decision dismissing claims against a health care provider, ruling that the plaintiffs' claims were not for medical malpractice (Angel Acosta, et al. v. HealthSpring of Florida Inc., No. 3D12-1340, Fla. App., 3rd Dist.; 2013 Fla. App. LEXIS 11358).

    D.C. Federal Judge Grants Summary Judgment To DHHS In Medicaid Reimbursement Suit

    WASHINGTON, D.C. - A federal judge in the U.S. District Court for the District of Columbia on July 15 granted summary judgment to the U.S. Department of Health and Human Services (DHHS) in a dispute regarding a "hold-harmless" provision for reimbursement under the "Disproportionate Share Hospital" (DSH) adjustments hospitals receive under the Medicare and Medicaid statutes (University of Kansas Hospital Authority, et al. v. Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services, No. 11-cv-1382, D. D.C.; 2013 U.S. Dist. LEXIS 98183).

    5th Circuit Affirms Merger Not 'Sale' For Purposes Of Depreciation Under Medicare

    NEW ORLEANS - A panel of the Fifth Circuit U.S. Court of Appeals on July 12 affirmed the denial of a request for a loss payment made by a Medicare provider following a merger, finding that the merger was not a bona fide sale as required by the Medicare statute (Memorial Hermann Hospital v. Kathleen Sebelius, secretary of the Department of Health and Human Services, No. 12-20654, 5th Cir.; 2013 U.S. App. LEXIS 14232).

    Michigan Federal Judge Denies Preliminary Injunction In Birth Control Suit

    DETROIT - A Michigan federal judge on July 11 denied a motion for a temporary restraining order and preliminary injunction in a challenge to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) brought by a management company owned by practicing Catholics (Mersino Management Co., et al. v. Kathleen Sebelius, et al., No. 13-11296, E.D. Mich.; 2013 U.S. Dist. LEXIS 96588).

    4th Circuit Affirms Dismissal Of Challenge To Health Care Reform Act

    RICHMOND, Va. - In a case remanded from the U.S. Supreme Court, a Fourth Circuit U.S. Court of Appeals panel on July 11 affirmed the dismissal of a case challenging the individual and employer mandates contained in the Patient Protection and Affordable Care Act (PPACA) (Liberty University, et al. v. Jacob J. Lew, et al., No. 10-2347, 4th Cir.; 2013 U.S. App. LEXIS 14052).

    9th Circuit Says N.J. Violated Medicaid When Changing Payment System

    PHILADELPHIA - In partially affirming and partially reversing a lower court, a panel of the Ninth Circuit U.S. Court of Appeals on July 9 held that New Jersey's requirement that Medicaid wraparound payments be contingent on prior managed care organization (MCO) payments violated the federal Medicaid statute's requirements that federally qualified health centers (FQHCs) timely receive full wraparound payment for all Medicaid-eligible claims (New Jersey Primary Care Association Inc. v. State of New Jersey Department of Human Services, et al., No. 12-3220, 3rd. Cir.; 2013 U.S. App. LEXIS 13881).

    9th Circuit Holds California Law Eliminating Coverage Violates Medicaid Act

    SAN FRANCISCO - In reversing a lower court, a Ninth Circuit U.S. Court of Appeals panel on July 5 held that California legislation eliminating coverage for certain health care services, including adult dental, podiatry, optometry and chiropractic services, conflicted with the Medicaid Act and, therefore, was invalid (California Association of Rural Health Clinics, et al. v. Toby Douglas, et al., Nos. 10-17574, 10-17622, 9th Cir.; 2013 U.S. App. LEXIS 13651).

    7th Circuit Affirms Dismissal Of Prescription Drug Headline Fraud Case

    CHICAGO - A panel of the Seventh Circuit U.S. Court of Appeals on July 8 affirmed the dismissal of a class action complaint alleging that a prescription drug manufacturer and pharmacy engaged in a scheme to defraud insurers (United Food and Commercial Unions and Employers Midwest Health Benefits Fund v. Walgreen Co., et al., No. 12-2077, 7th Cir.).

    Colorado Federal Judge Defers Ruling On Motions In Birth Control Case

    DENVER - A Colorado federal judge on July 3 deferred a motion for a preliminary injunction or a temporary restraining order pending a ruling on the motion for a preliminary injunction in a case brought by the owner of for-profit senior care assisted living centers and skilled nursing centers in a suit challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA), pending a ruling by the 10th Circuit U.S. Court of Appeals in a similar case (Stephen W. Briscoe, et al. v. Kathleen Sebelius, et al., No. 13-285, D. Colo.; 2013 U.S. Dist. LEXIS 93607).

    Judge Affirms Arbitration Award After Further Review In Payment Dispute

    DALLAS - A Texas federal judge on July 5 granted a hospital's request to reconsider his opinion affirming a magistrate judge's decision to deny the hospital's request to vacate an arbitration award in a reimbursement dispute with a health insurer but ultimately reaffirmed the decision for different reasons (Baylor Health Care System, et al. v. Equitable Plan Services Inc., No. 11-3023, N.D. Texas; 2013 U.S. Dist. LEXIS 94129).

    4th Circuit Affirms Health Care Act Applies To Claims For Miner Survivor Benefits

    RICHMOND, Va. - A unanimous Fourth Circuit U.S. Court of Appeals panel on July 5 affirmed that the doctrine of res judicata does not preclude survivors of black lung benefit claimants from filing survivors' benefits claims under the Patient Protection and Affordable Care Act of 2010 (Union Carbide Corp. v. Virginia Richards, No. 12-1294 $(consolidated$), 4th Cir.).

    Pharmacies' Monopsony Challenge To Medco, Express Scripts Merger Is Dismissed

    PITTSBURGH - A federal judge in Pennsylvania on June 28 dismissed claims made by pharmacies and pharmacy trade groups that the consummated $29 billion merger of pharmaceutical benefit management (PBM) companies Express Scripts Inc. (ESI) and Medco Health Solutions Inc. gave the merged PBMs monopsony power as purchasers of retail community pharmacy services in state markets (National Association of Chain Drug Stores, et al. v. Express Scripts, Inc., et al., No. 2:12-cv-00395-CB, W.D. Pa.; 2013 U.S. Dist. LEXIS 90763).

    Judge: Challenge To Health Act's Individual Mandate Fails To State Proper Claims

    WASHINGTON, D.C. - A District of Columbia federal judge on June 28 granted the government's motion to dismiss an amended complaint challenging the Patient Protection and Affordable Care Act (PPACA), holding that the suit was foreclosed by a U.S. Supreme Court decision governing the individual mandate and that the act was properly introduced in the House of Representatives (Matt Sissel v. United States Department of Health and Human Services, et al., No. 10-1263, D. D.C.; 2013 U.S. Dist. LEXIS 91071).

    10th Circuit Reverses Denial Of Preliminary Injunction In Birth Control Suit

    DENVER - The 10th Circuit U.S. Court of Appeals on June 27 reversed and remanded with instructions to the lower court an appeal brought by the arts and craft company Hobby Lobby Stores Inc. and its owners, who were challenging a decision denying their request for a preliminary injunction to halt the implementation of a mandate contained in the Patient Protection and Affordable Care Act (PPACA) related to the provision of birth control (Hobby Lobby Stores Inc., et al. v. Kathleen Sebelius, et al., No. 12-6294, 10th Cir.; 2013 U.S. App. LEXIS 13316).

    Plan Administrator That Didn't Supervise TPAs Is Hit With $1.8M COBRA Penalty

    INDIANAPOLIS - A class of 741 former Visteon Corp. employees is entitled to more than $1.8 million in penalties based on the company's failure to provide them with timely notices of their rights to continued health care coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a federal judge in Indiana ruled June 25 (Darryl Pierce, et al. v. Visteon Corporation, et al., No. 1:05-cv-01325, S.D. Ind.; 2013 U.S. Dist. LEXIS 88817).

    High Court: Ban On Benefits For Same-Sex Married Couples Unconstitutional

    WASHINGTON, D.C. - In a 5-4 vote, the U.S. Supreme Court on June 26 struck down as unconstitutional Section 3 of the federal Defense of Marriage Act (DOMA), which defines marriage as the legal union between one man and one woman as husband and wife for purposes of all federal statutes. The decision means that same-sex couples married in states that recognize same-sex marriage as legal cannot be denied federal benefits under federal laws in which marital or spousal status is addressed (United States v. Edith Windsor, executor of the estate of Thea Spyer, No. 12-307, U.S. Sup.).

    Summary Reversal Denied In Birth Control Suit; Case Held In Abeyance

    WASHINGTON, D.C. - A panel of the District of Columbia Circuit U.S. Court of Appeals on June 21 denied a motion for summary reversal made by several Catholic groups appealing the dismissal of their case challenging a provision in the Patient Protection and Affordable Care Act (PPACA) mandating that all health plans provide preventive services for free, including those for birth control (Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-5091, D.C. Cir.).

    Fla. Appeals Court Reverses Decision, Says Evidence Of Full Medicare Rates Allowed

    LAKELAND, Fla. - In a personal injury case stemming from an automobile accident, a Florida appeals court on June 21 held that a trial court erred in not allowing an insurance company to introduce evidence that future medical expenses could be calculated at lower reimbursement rates under the Medicare program (State Farm Mutual Automobile Insurance Co. v. John Joerg Jr., individually and as natural father and guardian of Luke Augustine Joerg, Nos. 2D11-6229, 2D12-1246, Fla. App., 2nd Dist.; 2013 Fla. App. LEXIS 9840).